Over the last few years, more and more people have been turning to online psychotherapy. For those living abroad, in remote areas, with limited time, or looking for therapy in their mother tongue, the possibility of having sessions via video call has opened up new pathways to mental health care.
At the same time, the growing availability of online therapy has raised reasonable questions. Can a genuine therapeutic connection develop through a screen? Is something of human presence lost? And is online therapy as effective as face-to-face therapy?
Current research suggests that online psychotherapy can be effective for a wide range of psychological difficulties, particularly when there is a stable therapeutic relationship and active engagement on the part of the client. At the same time, certain limitations have been recognised, particularly those related to the absence of physical co-presence and some non-verbal aspects of communication. Research also suggests that the therapeutic alliance remains one of the most significant factors associated with positive outcomes in online therapy (Aafjes-van Doorn et al., 2024).
Beyond the question of effectiveness, however, it may be worth asking something deeper:
What is it that heals in psychotherapy?
Psychotherapy is not simply a process of working through problems. It is a human encounter. Clients do not come only to talk about their difficulties; they also come to experience a different way of being in relationship.
What does that mean?
It means having a space where they can express themselves without being judged; where they can say things they cannot say anywhere else; where they can be heard without having to prove their worth; and where they can gradually discover parts of themselves that may have remained hidden.
Seen from this perspective, therapeutic change is not the result of technique alone. It emerges within the relationship. And that is something that does not depend solely on whether two people are sitting in the same room.
Psychotherapy addresses fundamental human concerns: anxiety, fear and inner conflict, loneliness, freedom, responsibility, uncertainty, the meaning of life and our awareness of mortality. From this perspective, therapy is not necessarily limited by physical distance. On the contrary, it can become a space in which a person encounters themselves within the real conditions of their life.
For Greeks living abroad, existential questions may become particularly prominent: a sense of alienation, the feeling of standing between two worlds, the loss of familiar points of reference, and questions of belonging. In this context, being able to speak in one’s mother tongue with a therapist who understands one’s cultural background can become a bridge to meaning and connection.
The relational perspective in psychotherapy holds that people are shaped within their relationships, and that many psychological wounds and difficulties have relational roots. Although the screen introduces a different framework for communication, relational processes continue to unfold within the therapeutic relationship.
Clients may bring with them experiences of not feeling heard, fears of criticism, patterns of emotional withdrawal, or difficulties expressing their needs. These patterns can become visible and be explored within therapy, just as they can in face-to-face work.
Another important advantage of online psychotherapy concerns access to mental health services. In many countries, particularly where public health systems are under strain, waiting lists for psychotherapy can extend for many months or even longer.
For many people living far from their country of origin, online psychotherapy is not a second-best option. It is a genuine opportunity to receive support, reconnect with themselves, work through their difficulties, and create a consistent space for psychological care wherever they happen to be.
Being in their own familiar surroundings may also make it easier for some people to open up gradually and at their own pace.
Many Greeks living abroad choose to work online with Greek-speaking psychotherapists, both because of language and cultural understanding and because the cost of therapy may be considerably lower than in their country of residence. For some, this makes it possible to continue a therapeutic process that might otherwise be financially difficult to sustain.
The therapeutic relationship is not built through physical proximity alone. It is built through authentic presence, empathy, trust and the possibility of genuine mutual encounter.
This can be particularly important for people who find it difficult to sit in the same room with someone they do not know, who feel uncomfortable in their bodies, or who struggle to share personal experiences in unfamiliar surroundings. For some, having therapy from the safety of their own space can make opening up feel more possible.
The screen may initially function as a kind of protective frame, creating enough distance for a person to gradually feel safe enough to come closer emotionally.
As one client said to me recently—someone I had never met in person, who finds it particularly difficult to speak about personal matters even with people she has known for years:
“If we weren’t doing our sessions online, I don’t think I would have started therapy at all. I wait all week for this hour, because it is the only place where I can talk about everything I cannot say to anyone else.”
The essence of psychotherapy lies not simply in the distance between bodies, but in the quality of presence.
No screen can fully replace meeting another person in the same physical space. And yet human contact is not confined to physical proximity.
When there is trust, authenticity, commitment and genuine interest, a therapeutic relationship can grow—and can become deeply meaningful and transformative—even across distance.
References:
Katie Aafjes-van Doorn, Daniel S. Spina, Sarah J. Horne, Vera Bekes, The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis, Clinical Psychology Review, Volume 110, 2024, 102430, ISSN 0272-7358, https://doi.org/10.1016/j.cpr.2024.102430
Norwood C, Moghaddam NG, Malins S, Sabin-Farrell R. Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta-analysis. Clin Psychol Psychother. 2018;25:797-808. https://doi.org/10.1002/cpp.2315
